Organization
HARRIS TEETER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (PHARMACY LICENSING MANAGER)
(513) 762-1019
Entity
Organization
Contact information
Practice address
43300 SOUTHERN WALK PLAZA, SUITE 130, ASHBURN, VA 20148
(703) 723-0981
(704) 844-6556
Mailing address
701 CRESTDALE RD, MATTHEWS, NC 28105-1700
(704) 844-3100
(704) 844-6556
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0201004149
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639209786
—
VA
01
—
4840004
NABP
—
Enumeration date
03/07/2007
Last updated
03/07/2023
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